PERSONAL DATA FORM CONFIDENTIAL

Please ensure that the details provided on this form are correct and complete in all respects, as this information will be used for
background screening purposes and all other official requirements. Details once submitted, cannot be edited later. Any changes
required in the form submitted would require your Employer’s/Manager’s Approval. Details filled should match with the CV used
during the interview process and should also match with the supporting documents being submitted. Any deviations in the same
would require your Employer’s/Manager’s Approval. All the details should be filled and none of the fields should be left blank,
fields which are not applicable should be filled as “Not Applicable”.

FIRST NAME MIDDLE NAME SURNAME

 In case of name change please provide documentation for same.

PERSONAL INFORMATION
Male
Date of Birth D D M M Y Y Y Y Gender
Female

Father’s Name Nationality

Contact No. Mobile No.

SSN/NIC (if applicable) Marital Status

Former/Maiden Names
Date(s) of Name Change
(if applicable)

Disability ( Yes /No) Caste (Mention whichever

applicable)
If “Yes” – Mention type
of disability (General / SC/ ST/ BC /
OBC)

Address
 Please mention the full and complete address with landmark.
 Please mention correct pin code, period of stay and correct contact details (landline as well as mobile)
 Provide any documentation to as address proof.
Current Address Permanent Address

Landmark: Landmark:
PIN PIN
Residing From M M Y Y Y Y Residing From M M Y Y Y Y
Residing To M M Y Y Y Y Residing To M M Y Y Y Y
Contact No. Area Code Contact No. Area Code

Mobile No. Mobile No.

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 EDUCATIONAL QUALIFICATIONS
 Please provide highest qualificationdetails.
 Please attach copy of final years’ marks sheets & Degree (Convocation)certificate
 Note: Please ensure that the highest qualification details and tenure mentioned in CV should match exactly
with the details which you will write in BGVform
Dates Attended (MM YY) Name & Address of ID/Roll
Level Qualification Mode University
From To Institute/College No.

PG
Full Time
PG
Diploma / Part Time
Certificate

Distance
Graduation

Diploma

12th

10th

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EMPLOYMENT HISTORY
 Please provide employment history for your last (2) employments.
 Start with your most recent/current employer, followed by details of the employment preceding that.
 Ensure that you are descriptive wherever necessary; e.g. if the company has closed/ceased operations/moved location, do
mention it.
 Employee Code/ ID/ Number of your previous employer are mandatory.
 Provided documentation should be issued by the ex-company or on the letter head of the ex-company(other than
Resignation letter)Note: Please ensure that the employment details like tenure and employer name mentioned in your
CV should exactly match with the details you will write below and with the documents you submit
Full Name of Employer1 (Organization)
Employer’s Address
Current/Most Recent Employment

Company Contact Nos.

Employee Code Designation Internal Grade Department

Employment Period From Employment Period To Salary Details

DD / MM / YYYY DD / MM / YYYY
Type of Employment Details of Agency (if deployed from another
agency)
Permanent Temporary Contractual
Reason for Leaving Are you currently employed with this Company?
Yes No
Can a reference be taken now? If ‘No’, please indicate date when reference
can be taken?
Yes No
Name of Supervisor Board No. & Extn Designation & Email id
Department

Please tick mark the documents submitted for this employment: Relieving
Letter Service Certificate Appointment Letter Salary Slip Others None
(please
specify)
Full Name of Employer2 (Organization)
Employer’s Address
Prior to current employer (If applicable)

Company Contact Nos.

Employee Code Designation Internal Grade Department

Employment Period From Employment Period To Salary Details

DD / MM / YYYY DD / MM / YYYY
Type of Employment Details of Agency (if deployed from another
agency)
Permanent Temporary Contractual
Reason for Leaving Are you currently employed with this Company?
Yes No
Can a reference be taken now? If ‘No’, please indicate date when reference
can be taken?
Yes No
Name of Supervisor Board No. & Extn Designation & Email id
Department

Please tick mark the documents submitted for this employment: Relieving
Letter Service Certificate Appointment Letter Salary Slip Others None
(please
specify)

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 REFERENCE FORM

Please Note
The referees should be respectable persons holding senior positions from Central / State
Government / PSU /Priviate organizations or any reputed organization and knowing him / her for
at least 1 year.

At least 1 referee should be a person who has supervised you in a professional capacity at some
stage in your career (wherever applicable).

The referees should not be:

Relatives / friends of the candidate (If candidate is Experienced)
The referees would be directly contacted by either us or our Background Verification Agency for the purpose of reference chec k and the
feedback should be given directly by the referees.
The referee has to respond to us or the Background Verification Agency via his / her official email ID/ Call. If this is not possible the reference
check letters should be provided on the referee’s official letterhead. If it is not possible to use official letterhead, the letter should be duly signed
in official capacity with the referees visiting card attached.
Emails from personal id’s will not be accepted.
If Fresher- Provide Academic References (Lecturers/HODs/Principal Father/mother/sister/brother))

REFERNCE 1

Name of the referee : ____________________________

Relationship with the candidate : _____________________________

Designation of the referee : ____________________________

Organization Name (referee) : ____________________________

Referee’s Contact no./Alternate Contact : ____________________________

Referee’s Official E-mail I.D. : ____________________________

REFERENCE 2

Name of the referee : ____________________________

Relationship with the candidate : ____________________________

Designation of the referee : ____________________________

Organization Name (referee) : ____________________________

Referee’s Contact no. & Alternate Contact : ____________________________

Referee’s Official E-mail I.D. : ____________________________

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 DECLARATION

“I hereby declare that the information I have given is true and correct to the best of my knowledge. I understand that a
misrepresentation or omission of facts called for herein shall be sufficient cause for cancellation of consideration for employment
or dismissal from the Company’s service if I have been employed, without liability to the Company.
“I hereby authorize TMI & or any third party agent(s) and/or its agents to conduct verification of all statements contained in this
record if I am considered for employment. I understand that my employment is subject to satisfactory background verification.”

Date: DD / MM / YYYY Your Name: Your Signature:

AUTHORIZATION

“I hereby authorize TMI or any third party agent(s) appointed by the Company to contact any former employers, educational
institutes and all such sources as may be required to verify information provided in my resume and application of employment
and to carry out all Background Checks as may be deemed appropriate per the Company’s selection procedure. I authorize
former employers, agencies, educational institutes and all persons who may have information relevant to this enquiry to release
the information to TMI or their agents. I release all persons from liability on account of such disclosure. I am willing that a
photocopy of this authorization be accepted with the same authority as the original.”

Date: DD / MM / YYYY Your Name: Your Signature:

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